The humanitarian crisis in Syria is worse this year than ever before in the country’s seven-year-old civil war, a United Nations official said on Friday.

“We see in 2018 the humanitarian situation inside Syria being the worst we have seen since the war started: a very dramatic deterioration, massive displacement, disrespect of protection of civilians and people’s lives still being turned upside down,” Panos Moumtzis, U.N. Humanitarian Coordinator for the Syria crisis, said in Beirut.

Syria is the worst place in modern history in terms of attacks on healthcare workers and facilities, accounting for 70 percent of all such attacks worldwide, he said.

U.N. data shows 89 healthcare workers died in 92 confirmed military attacks on healthcare facilities between Jan 1 and May 4, compared to 73 killed in 112 attacks in the whole of 2017, U.N. Humanitarian Coordinator for the Syria crisis.

The two areas which saw the most healthcare attacks in 2018 were Eastern Ghouta and Idlib.

Eastern Ghouta had been the largest rebel-held pocket near the capital Damascus, but came back under government control in mid-April after a fierce offensive.

Idlib, in northwest Syria, is the largest remaining area under opposition control, containing around 2.5 million people.

Idlib’s population has ballooned over the course of the conflict, with people there from fighting inn other areas. The government has also transferred a large number of rebel fighters and their families to Idlib as part of surrender deals elsewhere in Syria.

Syrian President Bashar al-Assad has vowed to take back every inch of Syria.

Moumtzis said the U.N. does not want to see a repeat of what happened in Ghouta happen in Idlib. He urged the warring sides to come to a peaceful solution.

Moumtzis also said he was concerned about poor aid access in Syria.

In 2017, 27 percent of requests made by the U.N. to Syrian authorities for permission to deliver aid were granted. In the first four months of 2018 only seven percent were granted, Moumtzis said.

The number of people designated by the U.N. as living in besieged areas has fallen dramatically this year to stand at 11,100, after the Syrian government took back control of almost all rebel-held pockets around the capital Damascus.

But 2.05 million people in need of humanitarian assistance still live in hard-to-reach areas, the U.N. said.

For the first time, six years into a war that began with Syria’s secret police accused of torturing teenagers and has escalated in brutality ever since, a member of the Syrian military has been convicted of a war crime.

The perpetrator: a low-level soldier who is now in Sweden as a refugee. The crime: violating human dignity by posing with his boot on a corpse. The sentence: eight months in a Swedish prison.

Anticlimactic? At first glance, yes, for those who want Syria’s president, Bashar al-Assad, and other senior officials tried for far more serious crimes like using chemical weapons, bombing hospitals, and detaining and torturing tens of thousands of people.

Yet the ruling, issued last week in Sweden, is a landmark event, legal experts and human rights advocates say, the first conviction in any court of anyone from the Syrian government’s side for crimes committed in the multisided war.

It offers a glimmer of hope that courts outside Syria can hold at least some war criminals accountable on all sides of a conflict that has claimed nearly half a million lives, even now that Mr. Assad is looking more and more likely to stay in power.

As hopes fade for a political transition that could bring a full reckoning inside the country, Syrian and international advocates say there is new urgency to the search for other avenues to document and punish war crimes. In that context, they said, even this small victory is promising.“Thank you for justice,” Rami Hamido, a lawyer who fled to Sweden from Syria and helped prosecutors build the case, said he told the judge after the ruling.

The conviction also provides a test case for how social media documentation — a voluminous portion of the available record of suspected war crimes in Syria — can and cannot be used as evidence in court.

The soldier, Mohammad Abdullah, 32, arrived three years ago in Sweden, where other Syrian refugees spotted him through his Facebook posts. They connected him to a photograph he had posted earlier, showing him standing over a pile of bloody bodies, smiling, with his boot on one corpse.

At first, the prosecutor, Henrik Attorps, charged him with killing the people shown in the picture, but the court ruled that the picture did not prove he was the killer. So Mr. Attorps brought a second case, charging Mr. Abdullah with violating the dead man’s dignity.

“There is an international duty to act on these crimes,” Mr. Attorps said in a telephone interview. “Sweden should not be a safe haven for war criminals.”

The decision came just months after a setback for similar prosecution efforts in Spain. In July, a court there threw out a case that accused senior Syrian officials of war crimes in the death of a man whose sister spotted his corpse among photos of torture victims after a defector smuggled the images out of Syrian government prisons. A Spanish court had claimed jurisdiction in the case because the man’s sister was a Spanish citizen, but a higher panel rejected that argument.Prosecutors in Sweden and Germany have made more progress using the same legal principle, called universal jurisdiction. It holds that national courts can have jurisdiction over certain war crimes that take place outside their territory.

Swedish investigators are pursuing cases against an additional 13 people suspected of war crimes committed in Syria, and the German authorities are investigating 17 people suspected of crimes in Syria and Iraq, according to a Human Rights Watch reportreleased on Tuesday.

While Sweden focuses on cases that have a Swedish connection — a suspect, victim or witness in Sweden — Germany allows cases based on pure universal jurisdiction, with no national link required.

Both countries have convicted several fighters from the Islamic State and Syrian rebel groups, which advocates say is a step toward accountability. But without efforts to prosecute those on the government side, it risks giving the impression that the European authorities are concerned only with suspected Islamic State members who could pose a terrorist threat, which could discourage potential witnesses.

That such small steps are counted as victories is an indication of the difficulty of prosecution. Russia, the Syrian government’s most powerful backer, has used its United Nations Security Council veto to block attempts by the United States and its allies to refer Syrian war crimes suspects to the International Criminal Court.

And there are challenges even in the countries making the most efforts, Human Rights Watch reported. The group called for Sweden to expand its prosecution staff and conduct more outreach in Arabic to let refugees know they can file complaints, and noted that in Germany the authorities are struggling to sift through thousands of tips.

Both countries are also carrying out broader investigations intended to document suspected crimes by Syria’s military and prison systems, information that is not linked to specific cases but could provide context in some future, higher-level prosecution.

As for the individual cases, Salma Kahale, a Syrian activist who works with families of torture and detention victims, said, “For now, I see this as mainly symbolic, a continuation of our cry in the wilderness.”

The main value of the narrow, low-level cases in Europe, he said, is “the message it sends to both victims and their families and to regime officials that war criminals will not be able to get away with what they did, at least in Europe.”

He said the prosecutions could also serve a political purpose. They could make it more difficult, he said, for Western countries to normalize relations with the Syrian government without at least trying to impose conditions such as releasing detainees and providing information on detainees who have disappeared.

But at the same time, he said, it is important for the prosecutions themselves to avoid politicization that could harm their credibility.

Iran’s Islamic Revolutionary Guards Corps (IRGC) has recruited Afghan immigrant children living in Iran to fight in Syria, Human Rights Watch said today. Afghan children as young as 14 have fought in the Fatemiyoun division, an exclusively Afghan armed group supported by Iran that fights alongside government forces in the Syrian conflict. Under international law, recruiting children under the age of 15 to participate actively in hostilities is a war crime.

Human Rights Watch researchers reviewed photographs of tombstones in Iranian cemeteries where the authorities buried combatants killed in Syria, and identified eight Afghan children who apparently fought and died in Syria. Iranian media reports also corroborated some of these cases and reported at least six more instances of Afghan child soldiers who died in Syria. For two of the reported cases, researchers reviewed photographs of tombstones that indicated the individual was over the age of 18, but family members of these deceased fighters told Iranian media that they were children who had misrepresented their age in order to join the Fatemiyoun division. This indicates that instances of Iran recruiting children to fight in Syria are likely more prevalent.

“Iran should immediately end the recruitment of child soldiers and bring back any Afghan children it has sent to fight in Syria,” said Sarah Leah Whitson, Middle East director at Human Rights Watch. “Rather than preying on vulnerable immigrant and refugee children, the Iranian authorities should protect all children and hold those responsible for recruiting Afghan children to account.”

Since 2013, Iran has supported and trained thousands of Afghans, at least some of them undocumented immigrants, as part of the Fatemiyoun division, a group that an Iranian newspaper close to the government describes as volunteer Afghan forces, to fight in Syria. In May 2015, Defa Press, a news agency close to Iran’s armed forces, reported that the Fatemiyoun had been elevated from a brigade to a division. There are no official public statistics on its size, but according to an interview published in the Revolutionary Guards-affiliated Tasnim News, it has about 14,000 fighters.

By reviewing photographs of their tombstones, Human Rights Watch documented eight Afghan children who fought and died in Syria. Five of them, one as young as 14, are buried in the Martyr’s Section of Tehran’s Behesht-e-Zahra cemetery. Writing on the epitaphs of the tombstones indicates that they were all probably killed in combat in Syria and that all of them were below the age of 18 at the time of their deaths. Human Rights Watch was able to document three more cases, of a 17-year-old, a 15-year-old, and another 17-year-old, who were buried in Alborz, Tehran, and Isfahan provinces, respectively.

In four of these cases, the tombstones also identified the children’s places of death in Syria, and in seven of the eight cases, the tombstones described the Afghan child as a “defender of the shrine,” the euphemism the Iranian government uses to describe fighters it sends to Syria. Domestic media reported their funerals and memorial services, along with their membership in the Fatemiyoun division and their place of “martyrdom” in Syria.

Domestic media reports also indicate that at least six more “defenders of the shrine” from the Fatemiyoun division are buried across the country and were under the age of 18 when they died. In two of these cases – Hassan Rahimi and Mohammad Zaman Atayi – information engraved on their tombstones indicated that the two were over 18 when they died, but media interviews with their families reveal that they were actually both children, or under 18, when they died fighting in Syria.

For instance, Isa Rahimi, the father of deceased Afghan child soldier Hassan Rahimi, told Iran’s Quran News Agency in November 2016, “On his tomb, his birthday is printed as 1995, but his real birthday is 1999. He had lied about his age so they would allow him to join the forces easier. They hadn’t asked him for a birth certificate, and that’s how he got away with it.”

Afghan fighters have also said they have seen children in training camps for Afghan forces. “Ali,” a 29-year-old Afghan, told Human Rights Watch in August that he talked to 16 and 17-year-old child soldiers who were being trained to fight in Syria. Ali said he joined the Fatemiyoun division after a recruiter approached him while he was trying to renew his residency permit at the Bureau for Aliens and Foreign Immigrants Affairs (BAFIA) office in a city outside Tehran. He said the recruiter told him he could get his permit if he joined up.

“They never asked me to show any documentation, but they wanted to make sure we were Afghan nationals,” Ali told Human Rights Watch. “We had to be above the age 18 to be recruited, but they only asked for our age, not any documentation.”

Authorities have attempted to extend rights to Afghan children living in Iran. In 2015, Iran reportedly allowed all Afghan children, including undocumented ones, to register for schools after Supreme Leader Ali Khamenei issued a ruling emphasizing that “no Afghan child, even the undocumented ones, should be left out of school.” Yet, this research demonstrates authorities have done too little to protect Afghan children from being recruited to fight in Syria, particularly in light of the fact that the government has proposed offering incentives such as a path to citizenship for families of foreign fighters who die, become injured, or are taken captive during “military missions.” These incentives without sufficient protections could increase the risk of child recruitment; as the United Nations High Commissioner for Refugees’ Executive Committee has emphasized, “refugee children and adolescents… are particularly vulnerable to recruitment by government armed forces…” and has called upon governments to implement policies to prevent this human rights violation.

Under the Rome Statute of the International Criminal Court, “conscripting or enlisting children under the age of 15 years into national armed forces or using them to participate actively in hostilities” is a war crime. Iran is not a party to the Rome Statute, but is bound by customary international law which also provides that recruitment of children under age 15 is a war crime.The Optional Protocol to the Convention on the Rights of the Child on the involvement of children in armed conflict that entered into force on February 12, 2002, provides that 18 is the minimum age for direct participation in hostilities. Iran has signed the Optional Protocol, but the parliament has yet to vote on its ratification. Human Rights Watch has previously documented the use of child soldiers in the Syrian conflict by the People’s Protection Unit (YPG) – the Kurdish Democratic Union Party affiliate.

The UN should investigate child recruitment by the IRGC, and the secretary-general should consider adding the organization to his annual list of perpetrators of violations against children based on evidence of child recruitment, Human Rights Watch said.​“Iran should be improving protections for Afghan refugee children, not leaving them vulnerable to unscrupulous recruiting agents,” Whitson said. “Iran should immediately ratify the Optional Protocol and ensure that Afghan children are not being recruited to fight in Syria.”

By Ole Solvang​Dozens of people showed symptoms consistent with exposure to chemicals after aircraft attacked Khan Sheikhoun, a town in northern Syria, witnesses told us. While we are continuing to investigate, early reports suggest dozens were killed. Khan Sheikhoun is controlled by armed groups fighting against Syrian government forces.

International law prohibits chemical attacks. With 192 member states, the Chemical Weapons Convention is one of the strongest weapon bans in international law. Syria joined the convention and gave up its chemical weapons program in 2013 after a chemical weapons attack, likely carried out by government forces, killed hundreds in a suburb of Damascus.

But that hasn’t meant that Syrian government forces have stopped carrying out chemical attacks. Instead, chemical attacks have become a regular occurrence in Syria. Human Rights Watch has documented Syrian government helicopters dropping canisters filled with chlorine in dozens of cases. We issued reports on these attacks in May 2014, April 2015, June 2015, and September 2016. In our latest report, we documented that Syrian government forces conducted coordinated chemical attacks in November and December 2016 during the final stages of the battle for Aleppo.

We have also documented that the Islamic State (also known as ISIS) has used chemical weapons both in Syria and in Iraq.

While the United Nations Security Council has condemned chemical attacks in Syria on several occasions, Russia and China have used their vetoes to block sanctions on the Syrian government. Those responsible for past chemical attacks might have taken the lack of consequences as a green light to conduct more attacks.

Syrian government forces conducted coordinated chemical attacks in opposition-controlled parts of Aleppo during the final month of the battle for the city.

The continued use of chemical attacks in Syria by government forces and armed groups threatens to undermine the very strong ban against chemical weapons in international law, which may encourage their use by others.

The Security Council, including Russia and China, should condemn this latest attack and support steps to hold those responsible to account.

One evening in the early days of Syria’s uprising, Mohsen al-Masri’s band of activists slipped through the Damascus streets and waited for the coast to clear. Then they crouched, opened their bags and let out a stream of color.

Thousands of ping-pong balls, painted green, pink, blue and yellow, bounced past policemen, who scrambled to stop them. Residents would find balls tucked in nooks and crannies for months. Each was marked with a single word: “Freedom.”

The punishment for Masri’s acts of peaceful protest would begin a journey into hell, unusual not because of what he saw, but because he survived.

In a series of interviews, he described how he was tortured and interrogated over a two-year period in four detention facilities before arriving in a hospital at the heart of a nationwide system of brutality.​The hospital, known as 601, is not the only site of torture in Syria. But after it was seen in a cache of photographs showing thousands of skeletal corpses, it became one of the most notorious.

Inside the facility, about a half-mile from Syrian President Bashar al-Assad’s palace, sick prisoners are tortured as they lie shackled to beds crammed with dying men, according to Masri and former detainees and military personnel who worked there. Corpses have been piled in bathrooms, outhouses and anywhere else they will fit, then meticulously documented and trucked away for mass burial.

In interviews across Lebanon, Turkey and Europe, more than a dozen survivors and army defectors described horrors in Syrian military hospitals across the country for which war crimes lawyers say they have struggled to find a modern parallel.

The former detainees come from all walks of life. Elite, ­working-class, leftist and Islamist, their only connection to one another was involvement in Syria’s 2011 uprising. Some were its instigators. Others said they had simply commented on the Facebook statuses of friends who supported protests.

Investigators say that testimony and documentation from Syria’s military hospitals offer some of the most concrete evidence to date of crimes against humanity that could one day see senior government figures tried in court.

“We were swept into a system that was ready for us. Even the hospitals were slaughterhouses,” Masri said in an interview last month.

Medicine has been used as a weapon of war since the earliest days of the uprising, when pro-government doctors performed amputations on protesters for minor injuries.

Military hospitals across Syria have long set aside wards for prisoners. But since 2011, these have been packed with men left starving and broken by the conditions they have already endured.

More than 100,000 people have been arrested or forcibly disappeared in Syria since the country’s revolt began, according to a list compiled by the Syrian Network for Human Rights, a monitoring group. During that time, international aid groups have gotten access to only a handful of prisons with the government’s permission, none of which the detainees interviewed by The Washington Post spent time in.

Masri’s ordeal began in the spring of 2012 when he was arrested on his way to a conference in Turkey. Repeatedly tortured as he was transferred from jail to jail, he arrived at Sednaya, one of the most feared.

In a report published in February, Amnesty International said torture and forced starvation are systematic at the prison. But Masri said that prisoners learned to stay silent when guards asked who needed to go to the hospital.

“It didn’t matter what they did to us; we had to pretend we were fine. People rarely came back from those trips,” he said.

After months of starvation, Masri’s name was added to the weekly transfer list. As darkness fell on an evening in May 2012, he was chained to another man and taken to trucks outside. Attaching a number to Masri’s body, a guard told him to forget his name. Then he was blindfolded.

Everyone gets the “welcome” party, Masri said — a savage beating involving guards and medical staffers wearing white coats over military uniforms. In Hospital 601, the weakest man was pushed to the floor and brutalized first. In the nearby Tishreen Military Hospital, a former technician at the facility, Mohammed al-Hammoud, said he had seen prisoners dragged down steps by the hair.

“Everything was about control,” said Somar Mustafa, a physics student from Damascus who was sent to Hospital 601 at the end of 2012. Inside, he saw detainees chained to their beds and packed so tightly that they sat with their knees jutting into their rib cages.

Bathroom breaks were so rare that prisoners would defecate where they sat, remaining in the same spot for days. “We were blindfolded with that smell all around us. You can’t shake the memory of it, even when you leave,” Mustafa said.

At least five branches of the Syrian security forces have operated wards inside Hospital 601 since 2011, according to the U.N. Commission of Inquiry, a body set up to monitor the conflict. “Detainees, including children, have been beaten, burned with cigarettes, and subjected to torture that exploits preexisting injuries,” it said in a 2013 report. The commission concluded that many patients had been tortured to death inside the facility.

The Harasta Military Hospital, also in Damascus, moved its ward from the first floor to the seventh to prevent detainees from escaping, a defector said. “It was the only floor without an elevator, and we knew they couldn’t jump out the window.”

Investigators say the abuses could become central pillars in any eventual case for prosecution of the hospitals’ doctors, as well as senior figures in the Syrian government.

In 601, Masri and Mustafa said, they saw high-ranking officers from the security branches accompanying doctors on their rounds. Sometimes the teams would pause by a prisoner to discuss his treatment. Other times the men would beat him.

The doctors were helped by service staffers in blue uniforms, many of them former supporters of the revolt who had been co-

opted by their jailers. “Our best men had been broken by torture. If they didn’t beat us, they risked a worse fate themselves,” Masri said.

The guards went by nicknames to avoid identification. Four survivors said the most famous was known as Azrael, or the Angel of Death. They described him as a thickset man from Assad’s coastal stronghold of Latakia who carried a stick laced with razor blades. They said he selected prisoners, most of them deathly ill, for a fate he called “justice.” The detainees called it execution.

Masri recalled Azrael taking a lighter to a plastic bag and melting it drop by drop onto a prisoner’s face until he died, apparently of a heart attack. Other prisoners said he used an iron rod to smash their bedmates’ skulls.

Many died where they lay, slumped against their bedmates until morning came. For Mustafa in the winter of 2012, that meant sharing a bed until sunrise the next day with three corpses.

As the uprising outside morphed into a war, former prisoners say, their interrogators became obsessed with the notion of accomplices, torturing prisoners to extract the names of new suspects to arrest.

Documents signed by senior government and security officials acknowledged the upsurge in deaths, at times complaining that the bodies were building up.

“It’s impossible to interrogate, torture and kill tens of thousands of detainees without a system in place,” said Scott Gilmore, a staff attorney at the Center for Justice and Accountability. “Before the revolution, the regime was not generating thousands of dead bodies. Then all of a sudden it was. So what did you do with them?”

A December 2012 order signed by the head of Syria’s military intelligence department instructed every security branch to send their dead to a military hospital’s morgue. The document, obtained by the Commission for International Justice and Accountability, a Europe-based investigative unit, said that each body should be examined and logged.

A trove of these photographs was published around the world in 2014, after being smuggled out of Syria by a military police defector known only by his code-name, Caesar. Most were taken inside Hospital 601. Skeletal bodies of children as young as 11 bore signs of torture, with eyes gouged out and limbs drilled through and burned. Following Syrian government protocol, Caesar had methodically documented the deaths of some 11,000 people.

“You have to realize that these were just the photographs taken by a single man during a single period, and even then, they were only a fraction of what he’d actually recorded,” said Nadim Houry, who examined the photographs for Human Rights Watch.

Assad recently described the images as “fake news,” suggesting they had been doctored to suit the aims of human rights groups.

But defectors describe hauling numbered bodies into transparent bags in Hospital 601 and nearby military hospitals in Tishreen and Harasta. Investigators from the United Nations and private law firms have collected similar testimony from the cities of Homs, Aleppo and Daraa.By late 2012, the system had buckled, and the December order berated individual military departments for failing to register their dead on time.

Those who survive are funneled back to nearby jails, Masri said. Others, like Mustafa, are released to a Damascus court packed with prisoners and dismissed from custody on the spot, after a judge acknowledges that they had been forced to make false confessions under torture. The young man said he remembers falling into the arms of his sobbing parents.

Masri’s discharge from 601 sent him back to Sednaya. Another year of torture followed, with nights spent packed next to other men in the darkness. He felt forgotten.

In the winter of 2014, he dreamed he was taking a hot shower, its stream stripping back two years of dirt and leaving him clean. He woke to find a guard in his cell. “He told me it was time to go,” Masri said. “I cannot describe that feeling. It was too much, too big. Indescribable.”Back home in Damascus, he said, he remembers closing the bathroom door to stand alone for a moment, shutting his eyes to finally feel at peace. When he opened them, he saw a sheet-white, rawboned man staring back from the mirror.​“I started screaming,” Masri said. He did not recognize himself.

A Spanish court has opened the first criminal case abroad over alleged torture instigated by Syrian officials during the country's civil war. It will focus on key political and security figures of the Assad regime.Spanish authorities are due to investigate nine Syrian officials over claims of torture and concerning the execution of a Syrian man four years ago, in what is the first criminal case against Syrian security forces accepted by a foreign court.

The case was brought by the deceased man's sister, a Spanish woman of Syrian origin, who says her brother disappeared after being illegally detained in 2013 in Damascus.

One image of Alhaj Hamdo "shows clear signs of torture," according to the charge sheet against the accused - who include Syria's vice president, intelligence chief and air force intelligence chief.

Investigating magistrate Eloy Valesco ruled Spain did have the jurisdiction to launch the probe. Spanish law allows the prosecution of serious crimes in other countries if there is a Spanish victim - which Velasco said the deceased man's sister, Amal Hag Hamdo Anfalis, could be considered as being.

Velasco has called on Anfalis and the forensic photographer to testify in court in April. He said the alleged crimes could constitute crimes against humanity, war crimes, torture and forced disappearance.

At least 320,000 people have died since the Syrian civil war began in 2011. Activists have tried to use European domestic courts to pursue justice for war crimes, given UN Security Council member Russia blocks the referral of Syria to the International Criminal Court.

Other cases have been filed in Germany and France, but have not yet been accepted by the courts, said lawyer Toby Cadman, who represents a London firm helping Anfalis.